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Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.

By submitting this application, I hereby authorize the employers listed above to release all information to Bartels Community. I also understand that this authorization is valid for 60 days. I waive any liability to the employers listed above, and its employees, from any claims of action for disclosure of information that could adversely affect any new employment opportunity.

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I certify that the above information is true and correct and give authorization for investigation of all statements and information contained in this application, my resume, and other documents or verbally obtained information obtained during an employment interview. I voluntarily consent to allow Bartels Community or any of their representatives or agents to check my references by contacting any persons, company or governmental entity they deem to be an appropriate reference. I understand that references questions may pertain to my personal or educational background, work experiences, character and behavior. I understand my employment is subject to satisfactory verification of this information and agree that deliberate falsification of this document or significant omissions shall be grounds for employment consideration disqualification or dismissal from employment, if discovered at a later date. I pledge, if hired, to comply with the guidelines of conduct and company policies and procedures of Bartels Community. I also realize that company policies, procedures, practices or statements made during an interview or employment do not create an employment contract by implication or otherwise. I further understand and agree that my employment is for no definite period of time and may, regardless of time and manner, be terminated by the company or myself with or without cause or previous notice. I understand that employment may be subject to satisfactory completion of physical examination and/or drug screening.

I understand that, if hired, I am entering into a co-employment relationship whereas Bartels Community is my worksite and directing employer. I agree that the benefit plans offered in my co-employment package are those of Bartels Community. and are the only benefit plans in which I am eligible to participate. I further agree that I will not be eligible for other benefits (if any) offered to other non co-employees of Bartels Community, now or in the future. I understand, if hired, I may be required to sign a non-compete/non-disclosure agreement. This application will be kept in a current file for thirty days. If not contacted during that period of time, it may be necessary to complete another application to receive further employment consideration.